Naidu Saiprasad, Singh Khwahish, Murray Tamiel, Drury Colin, Palermo Erin, Sucharew Heidi J, Xie Changchun, Boyne Pierce, Dunning Kari, Awosika Oluwole O
Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA.
Wright State University Boonshoft School of Medicine, Dayton, OH 45324, USA.
Brain Sci. 2025 Apr 24;15(5):437. doi: 10.3390/brainsci15050437.
Defined as a self-selected speed of <0.4 m/s, chronic stroke survivors falling in this category are classified as "severe", usually homebound and sedentary, and they experience worse outcomes. Limited rehabilitation strategies are available to improve walking speed and related outcomes in this subgroup, and questions regarding effective rehabilitation options remain. The objective of this study was to determine the effects of backward (BLTT) and forward (FLTT) locomotor treadmill training on overground walking speed, spatiotemporal symmetry, and dynamic postural stability.
In this single-center, assessor-blinded, randomized controlled pilot trial, 14 stroke survivors with severe waking impairment underwent 12 sessions of BLTT ( = 7) or FLTT ( = 7). The primary outcome was the proportion of participants reaching clinically meaningful important difference (MCID) on the 10-meter walk test following training completion. Secondary outcomes were between-group differences in walking speed, spatiotemporal symmetry, and completion time on the 3-meter timed up and go (3M TUG) at 24 h, 30 days, and 90 days POST.
Two subjects in the BLTT group (28.6%) and one (14.3%) in FLTT achieved MCID following training; however, most subjects did not, with significant variability in response. At 24 h POST, the median (IQR) percent change in walking speed was 28.9 (9.01-36.7) and 17.4 (12.6-39.7) with BLTT and FLTT, respectively; however, no between-group differences were seen ( = 0.80) at this time point or at 30 ( > 0.99) and 90 ( > 0.99) days follow up. Likewise, there were no significant between-group differences in spatiotemporal symmetry and the 3M TUG across time points.
While preliminary, this study found that 12 training sessions did not lead to group-level achievement of MCID for walking speed in our cohort and found no significant between-group differences in walking capacity or dynamic postural stability. Future well-powered dosing trials and mechanistically driven studies are needed to optimize and identify predictors of training response.
慢性卒中幸存者中，若自我选择的步行速度小于0.4米/秒，则被归类为“严重”，这类患者通常居家且久坐不动，预后较差。目前改善该亚组患者步行速度及相关预后的康复策略有限，有效康复方案的相关问题依然存在。本研究的目的是确定向后（BLTT）和向前（FLTT）运动平板训练对地面步行速度、时空对称性和动态姿势稳定性的影响。
在这项单中心、评估者盲法、随机对照试验中，14名有严重步行障碍的卒中幸存者接受了12节BLTT（n = 7）或FLTT（n = 7）训练。主要结局是训练完成后，在10米步行测试中达到临床意义上重要差异（MCID）的参与者比例。次要结局是在训练后24小时、30天和90天，两组在步行速度、时空对称性以及3米定时起立行走试验（3M TUG）完成时间上的差异。
BLTT组有2名受试者（28.6%），FLTT组有1名受试者（14.3%）在训练后达到了MCID；然而，大多数受试者未达到，反应存在显著差异。训练后24小时，BLTT组和FLTT组步行速度的中位数（IQR）百分比变化分别为28.9（9.01 - 36.7）和17.4（12.6 - 39.7）；然而，在该时间点以及30天（p >
0.99）和90天（p > 0.99）随访时，两组之间均未观察到差异（p = 0.80）。同样，在各时间点，两组在时空对称性和3M TUG方面也没有显著差异。
尽管本研究为初步研究，但发现12节训练课程并未使我们队列中的患者在步行速度上达到组水平的MCID，且两组在步行能力或动态姿势稳定性方面没有显著差异。未来需要进行有足够样本量的剂量试验和机制驱动的研究，以优化并确定训练反应的预测因素。
